EFFECTIVENESS OF VOLUNTARY COUNSELING AND TESTING (VCT) IN HIV/AIDS PREVENTION.
A STUDY OF THE ACTIVITIES OF AMINU KANO TEACHING HOSPITAL’S VOLUNTARY COUNSELING AND TESTING CENTER, KANO, NIGERIA*
BY
ZAKARIYYA MUHAMMAD SARKI
SMS/04/SOC/07276
*It is a project submitted in partial fulfilment for the award of BSc. degree in Sociology from the department of Sociology, Bayero University, Kano, Nigeria, November, 2007. And it has been accepted, approved and graded accordingly. Note that chapter four (data presentation and analysis) is omitted in this posting due to some reasons.
CHAPTER ONE
1.1 INTRODUCTION
HIV/AIDS was first discovered in 1981 in the US (Abdullah, 2006; Berry, 2007; UNAIDS 2007). Since then the disease has become one of the epidemics that affects human race. It has destroyed so many families and killed numerous people worldwide. In fact, statistics have shown that no disease is posing a great danger to Africa and the world more than the HIV/AIDS. According to the UN, for instance, more than 80 million people could die of HIV/AIDS, and that there are about 11 million orphans whose parents were killed by HIV/AIDS. It further said, “During 2005 alone an estimated 2 million adults and children died as a result of AIDS in Sub-Saharan Africa. Since the beginning of the epidemic more than 15 million Africans have died (from AIDS).” Furthermore, about 3.2 million people are likely infected daily. Unfortunately, despite this situation many people were and are still skeptical about the existence of the HIV/AIDS. This really discourages efforts towards cutting the menace of the disease.
However, with the wide publicity the issue of HIV/AIDS has been enjoying from various committed groups, individuals and organizations many people now believe in the existence of the disease. In a recently conducted work in Kano, Abdullahi (2005) studied risk groups – female sex workers, intravenous drug users, transport workers, out of school youth and in school youth. The data indicated that majority of them believed that AIDS is real, and many of them have at different times seen AIDS patients. Indeed, various claims and counter claims of curative and preventive measures for HIV/AIDS have been made. While almost all of the claims regarding the curative measures failed, many preventive measures stood the test of time. Quite a good number of governmental and non-governmental organizations (NGOs) have been involved in the search for at least preventive if not curative measure(s) for HIV/AIDS. These organizations participate through financial aids, provision of drugs, and in some cases establishing and maintaining VCTCs that will serve the need of individuals who are interested in knowing some thing concerning the HIV/AIDS.
It is believed that up till today there is no substantive cure for HIV/AIDS or rather none has been discovered. What is known for now is the antiretroviral drugs which only weakens (not kills) the HIV virus in the body of the patient, which means it only works on People Living with HIV/AIDS (PLWHA), not preventing future infection by other people. Unfortunately, again, only 1% of the PLWHA has access to the antiretroviral drugs in Africa. Ironically, many HIV/AIDS patients have to stop taking the drugs as a result of their side effects that include headache, dry mouth, skin rash, diarrhea, hair loss and anaemia among others.
These being the case, therefore, in an effort to reduce the widespread of the killer disease, preventive measures are mostly given importance. Morgan (2002) argued that since cure is years away prevention is the only treatments for AIDS. The VCTC located at Aminu Kano Teaching Hospital, Kano (AKTH), like any VCTC, is established in order to carry out the activities that are connected to the prevention of HIV/AIDS. The center basically offers counseling and even tests volunteering individuals for HIV/AIDS. It does that because the center believes that counseling PLWHA could make them to understand their situation and accept same thereby avoiding all avenues of transmitting the disease to other people. Also, it is through counseling that other individuals that are hitherto associating with PLWHA could be made to accept the latter as ‘normal’ human beings, and avoid stigma which seriously affects their (the PLWHA) psychological state and in the whole affects their health. In essence, the AKTH center is established to create enough awareness through counseling about and carry out voluntary testing on the HIV/AIDS which will at the end serve as a powerful preventive measure of the disease. According to Esther Gulume (2006), a UNICEF official in Africa, the number of orphans as a result of HIV/AIDS pandemic could continue to increase as a result of inadequate awareness about the disease by many people in the world and in Africa. Perhaps through voluntary counseling and testing as offered by the AKTH’s Voluntary Counseling and Testing Center, Kano, the inadequacies would be addressed.
Still, many people continue to be doubtful about the effectiveness of HIV/AIDS preventive measures, voluntary counseling and testing of a VCTC in this case. In other words, while some people believe in the effectiveness of VCTC’s activities in the prevention of HIV/AIDS others are yet to accept the idea, arguing that it is not easy to prevent a disease that one has no cure of. Being this an important and indeed interesting argument that has social significance, the researcher intends to conduct a research so that more light can be shed on some vital issues.
1.2 STATEMENT OF THE PROBLEM
As a disease like any other disease HIV/AIDS is no doubt a problem. However, more than any other disease the problem of HIV/AIDS is so serious that as at now statistics have shown that no disease is threatening the socio-economic and indeed political life of Africans; this include Nigerians. Nigeria has the highest population in Africa with 1 in every 6 Africans being Nigerian. This means that anything, negative or positive, that affects the country could have a serious impact on the whole continent. Although HIV prevalence rates seems to be lower in Nigeria than in other African countries such as South Africa and Zambia, the size of Nigeria’s population meant that by the end of 2005 there were an estimated 2.9 million people living with HIV/AIDS in the country. This is the largest number in the world after India and South Africa. This statistic could be true if one looks at the figure of the HIV/AIDS infection as at the end 2006 which is between 3.5-4.0 million people according to National Action Committee on Aids (NACA).
According to the 2006 national census result, Kano state, the case study of this research, is the most populous state in Nigeria with more than 9 million people. It follows, again, therefore that whatever affects the state, good or bad, must have a significant impact on the country in general, and by extension on the whole continent.
No doubt, having considered Kano as one of the Nigeria’s most important centers of both political and economic activities, the HIV/AIDS prevalence in Kano state is disturbing. According to the UNAIDS/WHO Epidemiological Fact Sheet-2004 update, in 1994, 10.89% of all commercial sex workers tested for HIV/AIDS are infected. In 2000, 7.20% of all injecting drug users and STI patients are also infected; in the same year again, 12.40% of Tuberculosis (TB) patients are infected with HIV/AIDS. More disturbing is the case of pregnant women whose problem usually extends to their babies (or foetus). Thus, according to the same Fact Sheet, in 2001, 3.67% and 4.33% of all pregnant women tested at Murtala Muhammad Specialist Hospital and Rano Hospital are infected with HIV/AIDS respectively. In December 2002, the overall prevalence rate of HIV in Kano was found to be 3.8%. Unfortunately, the results show increase in prevalence rate of HIV infection compared to previous years (Imoru et al, 2003). The rate is up till this time increasing.
According to the Technical Report on the 2003 National HIV/Syphilis Sentinel Survey Among Pregnant Women Attending Antenatal Clinics in Nigeria, carried out by the Federal Ministry of Health, the number of people infected by HIV/AIDS in Kano as at 2003 were 179, 842 and projected 205, 620 people would be infected by 2008. Out of these figures, youths, ages 15-24, account for 41,912 and 50,095 respectively. According to the same report, the number of HIV+ pregnant women was 15,558 and would be 17, 696 in 2008; number of AIDS orphans was 49,535 and would be 103,362 in 2008. The overall prevalence rate, according to the report, is 4.1% in Kano.
Furthermore, although the most obvious effect of this HIV crisis has been illness and death, the impact of the epidemic has certainly not been confined to the health sector; households, education, workplace and economies have been significantly affected, along with other sections of society. According to Fredrickson & Kanabus (2006), in all affected communities in Africa HIV/AIDS epidemic is bringing additional pressure to bear on the health sector. As the epidemic matures, the demand for care for PLWHA rises, as does the toll among health workers. They added, “The toll of HIV/AIDS on the households can be very severe also. Although no part of the population is unaffected by HIV, it is often the poorest sectors of society that are most vulnerable to the epidemic and for whom the consequences are most severe. Thus, in many cases, the presence of AIDS means that the household will dissolve, as parents die and children are sent to relatives for care and upbringing.” This no doubt affects the proper socialization of the children which can at the end affect the smooth running of a societal life at large. A study of rural South Africa has suggested that households where an adult had died from AIDS were four times more likely to dissolve than those where no deaths had occurred (Fredrickson & Kanabus, 2006).
One of the more unfortunate responses to a death in poorer households could be removing the children from school. Often, the school uniforms and fees become unaffordable for the families and the child’s labour and income-generating potential are required in the household. Really, the relationship between AIDS and the education sector is circular. There are numerous ways in which AIDS can affect education, but equally there are many ways in which education can help the fight against AIDS. The extent to which schools and other educational institutions are able to continue functioning will influence how well societies eventually recover from the epidemic. According to Peter Piot (2006), a Director of UNAIDS, “Without education, AIDS will continue its rampant spread. With AIDS out of control, education will be out of reach.”
Furthermore, AIDS weakens economic activity by squeezing productivity, adding costs, diverting productive resources, and depleting skills. Company costs for health-care, funeral benefits and pension fund committed are likely to rise as the number of people taking early retirement or dying increases. Also, as the impact of the epidemic on households grows more severe, market demands for products and services can fall. The epidemic hits productivity through increased absenteeism. For instance, comparative studies of East African businesses have shown that absenteeism can account for as much as 25-54% of a company’s costs (Fredrickson & Kanabus, 2006).
Moreover, the HIV/AIDS has a significant negative impact on life expectancy. A recent study found out that the average life expectancy of individuals living in sub-Saharan Africa has fallen by five years since the early 1990’s, mainly because of AIDS.
Obviously, the total impact of AIDS on different aspect of social life outlined above plus others not mentioned here could be the total political impact of HIV/AIDS on a society, since all social, economic, and even cultural problems usually end up on the shoulder of political institution.
The problem of HIV/AIDS is not only African, however. It is universal. Thus, according to different estimates in the US, for example, the number of HIV+ people is between 900,000 and 1.2 million (though UNAIDS currently estimates it to be 950,000). Unfortunately, around 30% of these are unaware of their infection and may unknowingly infect more people as a result. It is estimated also that 40,000 new HIV infections occur in the US each year, and although this is less than the 1980s peak of 150,000 new infections per year, the figure hasn't declined for the past decade. Of these 40,000 annual infections, about 70% are amongst males and about 30% females (Berry, 2007).
The same problem exists in china. According to CIA World Fact Book, in January 2006, the Chinese government along with WHO and UNAIDS jointly estimated that 650,000 people were living with HIV in China, including about 75,000 AIDS patients. During 2005 there were around 70,000 new HIV infections and 25,000 AIDS deaths. These large numbers have to be considered in the context of China's extremely large population which is estimated at around 1,300 million. If HIV/AIDS prevention is not made a priority in China, the country will be facing HIV epidemics that will be difficult to contain and expensive to deal with. HIV/AIDS in China could endanger national development and security, both personal and social. It is important to keep in mind that in China, the many millions who are vulnerable to HIV today do not belong to small isolated groups or pockets in society. Instead, vulnerable population interact extensively with the general population and in fact in many instances they are the general population (UNAIDS (2002) HIV/AIDS: China’s Titanic Peril).
Although the UK suffers from a relatively small HIV epidemic in comparison with some parts of the world, the impact of HIV has nonetheless been substantial amongst certain groups, in particular the gay community and, more recently, amongst people who have migrated to the UK (Pembrey, 2007).
According to the UNAIDS/WHO 2006 Report on the global AIDS epidemic, at the end of 2005 there were around 1.6 million people living with HIV in Latin America - more than in the U.S., Canada, Japan and the UK combined. While this region has often been overlooked in the past, there is now growing recognition amongst the international community that the HIV epidemics of Latin American countries demand more attention than they have received so far. This feeling is likely to be strengthened in 2008 when Mexico hosts the XVII International AIDS Conference, making it the first Latin American country to hold this prestigious event (Pembrey, 2007).
Considering what is so far outlined concerning the statistics, the prevalence rate and of course the negative impact of HIV/AIDS on world population in general, in Africa, Nigeria and Kano state in particular, one would have nothing than to believe that the HIV/AIDS epidemic is a serious problem that calls for urgent and sincere effort. Although both international and domestic efforts to overcome the crisis have strengthened in recent years, yet the epidemic is showing no sign of diminishing, and we may continue to feel the affects of HIV/AIDS for years to come. Perhaps, research to find out the efficiency of some preventive measures could help in this direction since the cure for HIV/AIDS is yet to be discovered.
1.3 OBJECTIVES OF THE STUDY
Specifically, this research has the following aims and objectives:
1.3.1 To shed light on the assumed direct relationship that is believed to be existing between HIV/AIDS prevention on the one hand, and voluntary counseling and testing as provided by VCTC on the other.
1.3.2 To help in solving the problem of HIV/AIDS that is every now and then hampering the socio-economic, political and general human development of our society.
1.4 DEFINITION OF TERMS
Unless otherwise stated in this research, the following terms should have their respective definitions as provided below:
1.4.1 HIV (Human Immunodeficiency Virus): a virus that attacks the body’s immune system and leaves the body unprotected from other infections.
1.4.2 AIDS (Acquired Immune Deficiency Syndrome): applies to the most advanced stages of HIV infection; it is a collection of the most common illnesses which characteristically affects people infected with HIV such as severe fever and headache.
1.4.3 Voluntary Counseling and Testing (VCT): a process of making individuals to understand themselves, the rights and needs of others, resolve conflict and define individual goals that affect their interests and aptitudes, as a result of which the individuals agree to be tested for infectious diseases like HIV/AIDS.
1.4.4 Voluntary Counseling and Testing Center (VCTC): a center that is basically established, and manned by professionals in order to provide counseling and carry out tests for infectious diseases such as HIV/AIDS on volunteering individuals.
1.4.5 Prevention: a process whereby certain precautions are taken in order to protect the occurrence of something.
1.5 SIGNIFICANCE OF THE STUDY
It is believed that in every society, nation or state, it is the ability of the younger population to think and act reasonably that determines its strength and development. That is to say the relationship between the strength and the development of a society on one hand and the ability of youth on the other is found to be direct. Thus, if a society has a healthy population that society would experience a speedy development. The reverse would be the case.
No doubt, HIV/AIDS is one of the diseases that affect youthful population of our society, ranging from ages 15-24. According to Dolan and Niven (2005), young people are at the forefront of HIV/AIDS epidemic as it continues to spread worldwide. They argued that young persons aged 15-24 years accounted for fifty percent of all new cases worldwide. It affects their normal thinking and acting. Various reports have indicated that HIV/AIDS is a serious threat to youth education, their relationship with their families, their economic activities, their political participation and general life endeavours. It follows therefore that any effort that will help in preventing the disease from further spread would be beneficial to the youth, and by virtue of the youth’s position in a society, beneficial to the society as a whole. Hence, this study being one of such efforts would also be beneficial and perhaps could make a tremendous contribution towards making healthy youths in our society; this could also mean society with development possibilities.
According to the National HIV Sero-Prevalence Survey published in April 2004, however, all age groups in Nigeria are affected by HIV/AIDS. And it is the same thing that is obtainable in all countries worldwide. Consequently, the epidemic is bringing additional costs to bear on the health sector; it makes children to lose their parents or guardians, and sometimes their childhood as well. The AIDS epidemic adds to food insecurity in many areas, as agricultural work is neglected or abandoned due to household illness. In fact, HIV/AIDS dramatically affect labour, setting back economic and social progress. It means, therefore, efforts are urgently needed to see to the end of this disease; and since it has no cure, at least for now, research to shed more light on the effectiveness of some preventive measures, such as this one, would be so significant. In other words, this study could help the society in its efforts in search for the prevention and possible cure for HIV/AIDS.
1.6 SCOPE OF THE STUDY
Although the findings of this research may be applicable to a wide area known as Kano and perhaps beyond it, the scope of this study is restricted to the activities of the VCTC situated at Aminu Kano Teaching Hospital. This becomes necessary as it is obviously not possible, considering the limited time and resources available, to study anything more than the said targeted activities.
Furthermore, the said scope is set as such due to the following reasons:
(a) The activities of VCTC at Aminu Kano Teaching Hospital are activities directly related to HIV/AIDS prevention.
(b) The outcome of the study may represent and show the level of effectiveness of VCTC as a means of preventing HIV/AIDS infection.
(c) The study, by its nature, is not intended to be all-encompassing and of course not final. Further researches can be built on in future in order to find out more explanation on the subject matter.
CHAPTER TWO
2.0 LITERATURE REVIEW AND THEORETICAL FRAMEWORK
In this chapter, an attempt would be made to review some of the relevant literatures as well as the theory that serve as a framework in this research. In other words, while some previous studies on the efficacy of VCTC carried out in different parts of the world would be reviewed in the chapter; a theory, symbolic interactionist theory, is presented to serve as a framework in this study.
2.1 LITERATURE REVIEW
The problem of HIV/AIDS, as it is highlighted earlier, is serious and universal. Consequently, many studies have been carried out at various times in order to find out the efficacy of its preventive measures. Particularly, the effectiveness of Voluntary Counseling and Testing (VCT) in HIV/AIDS prevention has been at the center of these studies. Some literatures were therefore available for the researcher’s review. Thus, in few paragraphs that would follow an attempt would be made to review some of these literatures.
An evaluation of VCT services for mineworkers in Welkom, South Africa was conducted to assess client and counsellor satisfaction, the quality of the services and to identify barriers to uptake of VCT. A cross-sectional survey was carried out using tools developed by UNAIDS, consisting of semi-structured interviews and observation of counselling sessions. Twenty-two nurse counsellors and six community volunteers were interviewed. Twenty-four counselling sessions were observed and 24 client-exit interviews were conducted. Although nine of the 22 nurse counsellors had only in-service rather than formal training for HIV counseling, whereas all community volunteers had been formally trained, nurse counsellors demonstrated better interpersonal skills than did community volunteers. Both clients and counsellors identified fear of a positive result as a major barrier to HIV testing. Clients also raised concerns about confidentiality (Ginwalla et al, 2002).
In another study in Zambia, couples were recruited from a same-day VCT center in Lusaka, in 2003. Sexual exposures with and without condoms were recorded at 3-monthly intervals. Sperm detected on vaginal smears, pregnancy, and sexually transmitted diseases (STDs) including HIV, gonorrhea, syphilis, and Trichomonas vaginalis were assessed. Results show that Less than 3% of couples reported current condom use prior to VCT. In the year after VCT, 80% of reported acts of intercourse in discordant couples included condom use. Reporting 100% condom use was associated with 39-70% reductions in biological markers; however most intervals with reported unprotected sex were negative for all biological markers. Under-reporting was common: 50% of sperm and 32% of pregnancies and HIV transmissions were detected when couples had reported always using condoms. Positive laboratory tests for STD and reported extramarital sex were relatively infrequent. DNA sequencing confirmed that 87% of new HIV infections were acquired from the spouse.
According to the Center for Diseases Control (CDC) of the US, a project tagged ‘RESPECT’, which was a national study aimed at evaluating the efficacy of HIV/AIDS prevention counseling in changing high risk sexual behaviors and preventing new sexually transmitted disease (STDs) and HIV, was conducted by the center in 2004. The project concluded with a large, multi-center randomized, controlled trial that compared two different brief- one-on-one counseling interventions and an informational messages intervention that is more typical of current practice. The trial enrolled men and women who came for diagnosis and treatment of an STD including HIV to one of 5 publicly funded STD clinics across the United States. In this study all participants agreed to have an HIV test and to come back to the clinics every 3 months for a full year to undergo behavioral questionnaires, STD examinations and tests, and HIV tests.
Over the six years project, 5,876 men and women with predominantly heterosexual HIV and STD risk enrolled in the study and were randomized to one of three HIV prevention interventions, either Enhanced Counseling i.e. interactive counseling sessions based on theories of behavioral science; Brief Counseling : short and interactive counseling sessions based on the CDC’s client-centered HIV Prevention Counseling model; or Didactic Messages i.e. brief information-only sessions that are typical of what is currently done at many test sites.
The study found that participants in both the Enhanced Counseling and Brief Counseling interventions reported significantly more condom use at 34 and 6 months post intervention compared with participants in Didactic Messages. Significantly fewer participants in both- the Enhanced and Brief Counseling interventions had new STDs including the HIV. After 6 months, 30% fewer participants in both counseling interventions had new STDs, and after 12 months, 20% fewer participants in both had new STDs. The STD reduction was similar for men and women. Subset analyses suggest that the counseling interventions were better for adolescents (45% fewer had new STDs) and for people who had an STD at the baseline visit (40% had new STDs).
Furthermore, to examine the determinants of uptake of Voluntary Counseling and Testing (VCT) services, assess changes in sexual risk behavior following VCT, and to compare HIV incidence amongst testers and non-testers, prospective population-based cohort study of adult men and women was conducted in Manicaland province of eastern Zimbabwe, which contains subsistence farming areas, roadside trading areas, small towns, and forestry, tea, and coffee estates. The cohort is part of the Manicaland HIV/STD Prevention Project, in which all local residents were enumerated, first in a baseline household census conducted from July 1998 to February 2000, and again three years later (referred to as the follow-up survey). Information on demographic and socioeconomic characteristics, HIV knowledge, and sexual behavior were collected. Responses to sensitive questions about sexual behavior were collected using an informal confidential system of voting. Dried blood spots were collected for HIV serological testing, which was performed using a highly sensitive and specific antibody dipstick assay. In parallel with the research, free HIV counseling and testing and free treatment for other sexually transmitted diseases were made available in the study areas through a mobile clinic service. The 12 sites were enumerated in succession with the mobile VCT clinic present within the study site at the time the survey was being conducted. Nine counselors used a systemic approach that emphasized the background of the client and tailored pre- and post-test counseling accordingly. VCT services provided primarily by non-governmental organizations were also available in the study areas and the provincial capital Mutare. The study population was males aged 17 to 54 years and females aged 15 to 44 years. The overall participation rate of individuals eligible for the cohort study was 79% at baseline (9,454/11,980) and 79% at follow-up (7,019/8,894). A total of 6,259 individuals (61% female) reported sexual experience at follow-up and were therefore included in the cross-sectional analysis. Of these, 5,775 individuals who participated in the baseline and follow-up study were analyzed for sexual behavior change and HIV incidence (Sherr et al, 2007).
The results show that HIV prevalence based on the undisclosed dipstick tests used in the survey was 20% and 18% for males and 26% and 22% for females at baseline and follow-up, respectively. At baseline, few study participants had ever received VCT (6.6%). At follow-up, 19% reported having had an HIV test at some point in the past, with males being significantly more likely to have been tested (26% males versus 14% females,), but less likely to have received the result after testing (46% males versus 71% females). Consequently, 12% of men and 10% of women in the study population had ever collected an HIV test result. The great majority of respondents (88%) said they wanted to know if they were HIV-infected. Of the 1,185 who had tested for HIV, 51% reported having received pre-test counseling. For both males and females, those who received pre-test counseling were significantly more likely to return for their results than those who did not (males: 82% versus 21%; females: 80% versus 53%). Psychological factors were the most common deterrent for testing (32%), followed by stigma and discrimination (8%) and the belief that knowledge of infection would accelerate disease progression (7%). For both sexes, increasing age was strongly associated with VCT uptake. Men who were tested (compared to those who were not tested) were less likely to live in roadside trading centers and reported more partners. Women who were tested were more likely to live in roadside centers and in subsistence farming areas. Being HIV-infected and having greater knowledge about HIV/AIDS were predictors for VCT in women, but not in men. Having any secondary/higher education was a significant predictor of testing in both sexes in all ages except 35-44. Men and women who received a positive result and post-test counseling had fewer sexual partners in the year prior to follow-up and women reported higher levels of condom use in their regular partnerships. Individuals who received a negative result and counseling were more likely to become risky in terms of beer hall attendance, new partners in the last year, and number of concurrent partnerships. Individuals who received a negative result but no counseling were more risky in terms of partners in the last month and last year. HIV incidence in males and females who tested negative at or near baseline did not differ significantly from those who had not tested at near baseline (Sherr et al, 2007).
This study demonstrated that, although many people were interested in learning their HIV status, uptake of VCT was low and increased slowly. Psychological factors were found to play a critical role in the decision to test, both as deterrents to testing and in subsequent behavioral responses, and must be considered as VCT is expanded and uptake increases.
The authors conclude, therefore, that motivation for VCT uptake was driven by knowledge of HIV and place of residence, rather than risk behavior. The slow uptake of VCT indicates that the provision of VCT by mobile clinics, based at the site where people have to give a sample specifically for personalized HIV testing, was not a sufficient mechanism to affect wide uptake of services in a three-year period. Increased sexual risk following receipt of a negative result may be a serious unintended consequence of VCT. Therefore, the authors suggest that such risks should be minimized with appropriate pre- and post-test counseling (Sherr et al, 2007).
In China, at the end of 2005, the free ART program served 20,453 AIDS patients, including approximately 17,000 former plasma donors, 600 drug users, and 100 men who have sex with men In addition to the social welfare support infected individuals and their families, individuals may also receive a monthly living allowance from their local government, which varies among the different provinces.
A major barrier to agreeing to have VCT was found to be the fear of stigma and discrimination. The Chinese government therefore commissioned several campaigns to reduce stigma and discrimination and has introduced new laws to protect the rights and confidentiality of the HIV infected individuals in an effort to ease their concerns and to increase VCT. In particular, Article 3 of the new Regulations on AIDS Prevention and Control (1 March, 2006), pledges to “protect the legal rights of people living with HIV/AIDS and their relatives. This includes the rights to marriage, employment, medical treatment and education. Any institution or individual shall not discriminate against people living with HIV/AIDS and their relatives.” (Zunyou Wu et al, 2006).
However, stigma and discrimination remain significant obstacles. Routine testing programs implemented on a wider scale—such that most people in the risk groups are tested—can potentially normalize HIV testing and lessen the stigma and discrimination associated with it. Although no formal evaluation of the testing campaigns has been undertaken, certainly, the ancillary effects of wide-scale testing—increased access to VCT raised public awareness about HIV, as well as normalizing the procedure of HIV testing—may have had a positive effect on reducing stigma in communities where HIV is prevalent. For example, in Henan, the number accepting VCT has increased since active testing was implemented (Zunyou Wu et al,2006).
In another study conducted, titled Efficacy of voluntary HIV-1 counselling and testing in individuals and couples in Kenya, Tanzania, and Trinidad: a randomised trial, with the aim to determine the efficacy of HIV-1 voluntary counselling and testing (VCT) in reducing unprotected intercourse among individuals and sex-partner couples in Nairobi (Kenya), Dar es Salaam (Tanzania), and Port of Spain (Trinidad), individual or couple participants were randomly assigned HIV-1 VCT or basic health information. At first follow-up (mean 7.3 months after baseline) health-information participants were offered VCT and all VCT participants were offered retesting. Sexually transmitted infections were diagnosed and treated at first follow-up. The second follow-up (mean 13.9 months after baseline) involved only behavioral assessment, and all participants were again offered VCT.
In this study, 3120 individuals and 586 couples were enrolled. The proportion of individuals reporting unprotected intercourse with non-primary partners declined significantly more for those receiving VCT than those receiving health information (men, 35% reduction with VCT is 13% reduction with health information; women, 39% reduction with VCT is 17% reduction with health information), and these results were maintained at the second follow-up. Individual HIV-1-infected men were more likely than uninfected men to reduce unprotected intercourse with primary and non-primary partners, whereas HIV-1-infected women were more likely than uninfected women to reduce unprotected intercourse with primary partners.
Couples assigned VCT reduced unprotected intercourse with their enrolment partners significantly more than couples assigned health information, but no differences were found in unprotected intercourse with non-enrolment partners. Couples in which one or both members were diagnosed with HIV-1 were more likely to reduce unprotected intercourse with each other than couples in which both members were uninfected. These changes were replicated by those in the health-information group diagnosed with HIV-1 at first follow-up. These data support the efficacy of HIV-1 VCT in promoting behaviour change. (The Lancet, 2000; 356(9224): 103-112).
According to Ekanem & Gbadegesin (2004), a study was carried out among 345 pregnant women attending antenatal clinics at two health facilities in Lagos, Nigeria. It was undertaken to determine their knowledge and acceptability of HIV voluntary counselling and testing in pregnancy as a strategy for the prevention of mother-to-child transmission (PMTCT) of HIV. Data were collected on issues relating to mother-to-child transmission of HIV, willingness to go for voluntary counselling and testing, actions to be taken if a pregnant woman was found to be HIV positive including infant feeding options.
Majority of the women (89.9%) had good knowledge of the modes of HIV transmission; however, knowledge of specific aspects of PMTCT was poor. Close to half of the women (41.7%) were not aware of the association between breast milk and HIV transmission. Almost all the women (96.1%) were willing to undergo HIV testing in pregnancy particularly if it would assist preventing transmission of HIV to their babies; but only few would undergo the test if the result would be shared with relatives (Ekanem & Gbadegesin, 2004).
Many of the women would still prefer breastfeeding even if they were found to be HIV positive. Awareness of anti-retroviral drugs among the study group was very poor. Most of the respondents had never been tested for HIV. Of the 345 respondents, only 135 (39.2%) had been tested in the past, mostly during ANC visits in previous pregnancies. Of those who were tested, only 34 (25.2%) received pre-test counselling, 20% had post-test counselling, while 68% were informed of their test results. Counselling was mostly done by the attending physician. The fact that only a few of those who had been tested for HIV were counselled is an indication of the fact that counselling services in the country are inadequate. Also, many health care providers are yet to fully understand the importance of counselling in HIV testing and patient management (Ekanem & Gbadegesin, 2004).
Willingness to undergo voluntary counselling and testing as seen in this study is a positive indication that the PMTCT initiative, which is about to begin in Nigeria, will likely attract a large number of beneficiaries. There is therefore a need for health workers to be adequately trained on counselling before HIV testing for PMTCT begins in any health facility. More awareness needs to be created about the availability and use of antiretroviral drugs in HIV management and MTCT. Innovative information and education techniques need to be developed for effectively providing HIV positive mothers with knowledge and skills that can enable them to make informed choices about infant feeding options as well as other forms of care. Even among women who are currently HIV negative, such knowledge and skills would enable them and their partners to adopt means that would reduce their chances of infection (Ekanem & Gbadegesin, 2004).
According to Donald et al (2000), between June 1995 and March 1996, 500 individual men, 500 individual women, and 515 couple members were recruited for a total sample of 1,515 participants in the Voluntary Counseling and Testing Efficacy Study at the study site in Nairobi, Kenya. The purpose of the study was to test the effectiveness of Voluntary HIV Counseling and Testing (HIV VCT) to reduce sexual risk behavior. Participants were young (average age 29 years) and of low income. High levels of risk behavior and self-reported STD symptoms and a high rate of HIV seropositivity among those tested at baseline (15% of men and 27% of women) indicate that an at-risk sample was recruited. Women and participants reporting symptoms of a sexually transmitted infected were significantly more likely to be infected with HIV. Findings suggest that HIV VCT services combined with STD diagnosis and treatment and economic development services could motivate more at-risk individuals and couples to receive counseling and testing.
In another study conducted participants were interviewed about risk behaviors and HIV testing history before VCT was provided as part of the study. Of 825 IDUs who participated, 36% reported a prior HIV test. Factors associated with prior HIV testing in multiple logistic regression analysis included higher education and having >1 lifetime sex partner. Needle sharing was not associated with prior HIV testing. Of the 298 men with a prior test, 80% reported a negative result on their last prior HIV test, of which 28% tested positive in our study, leading to an estimated incidence rate of 10.2 per 100 person-years. Fifty-nine percent of the 88 IDUs who reported a prior HIV test stated that they did not receive pre- and/or posttest counseling. HIV incidence among IDUs remains high despite having VCT. Extending HIV prevention and harm reduction programs is urgently needed for IDUs in the region (Kawichai et al, 2006)
In summary, the literature so far reviewed gave us contrasting results. Thus, while in almost all of the studies the importance of VCT is upheld, the VCT services are not, in some cases however, as effective as they are expected to be. This is as a result of different reasons. Datye et al (2006) summarized it all. According to them, many countries (in Africa) are gradually instituting VCTC as part of their Primary Health Care package. For example "...access to care, counselling and support" for HIV/AIDS and STDs is one of the top 10 national priorities in South Africa. However, closer examination in the country reveals personnel and skill shortages, inability of half the primary health care (PHC) clinics to provide antenatal services, and HIV testing being offered in only 56%. Condom availability is generally good, but termination of pregnancy is undertaken in a bare 27% of hospitals. In other regions of Africa, they added, VCTC is also deficient in many respects: medical services are often unavailable, support is absent, availability is restricted and there are few trained counselors. Consequently, workloads are heavy. A third of women worldwide receive no antenatal care, and just 60% of the roughly 133 million annual births throughout the world are attended by trained health personnel. Even when VCTC services are available, they are often not acceptable. They further argued that the overwhelming majority of African women appear to accept HIV testing, but only a proportion (59-61% in recent intervention trials) return for the results. They therefore recommended that for a positive impact of VCTC services, facilitated decision-making, acceptance and coping with HIV, improved family and community acceptance, increased condom use, and reduced gonorrhea rates and HIV transmission should be given utmost importance.
2.2 THEORETICAL FRAMEWORK
Sociological theory, according to Ritzer (2003), is a set of interrelated ideas that allow for the systematization of knowledge of the social world; the explanation of social world and the prediction of its future. It is an attempt to identify general properties that explain regularly observed events. Theories (plural) involve constructing abstract interpretation that can be used to explain a wide variety of empirical situations. They also basically form an essential element of all sociological works. In other words, they serve as a framework of all sociological studies (Giddens, 2006). Sociological theories are many; one of them is the symbolic interactionist theory, the theory the researcher to uses as a framework in this study.
Symbolic interactionism which is sometimes described as a phenomenological perspective because of its emphasis on the actor’s views and interpretation of social world (Haralambos & Holborn, 1980) is concerned with the inner or phenomenological aspects of human behavior. Cooley and Mead, seen as co-founders of symbolic interactionism, both concluded that each person’s sense of self is ‘socially created’. In effect, we come to see ourselves as others see us; thus, we learn to view ourselves ‘from outside’. The essence of humanness – our ability to contemplate our own existence, our past, and our future – comes to us from society (Stark, 1989). For this reason, sociologists refer to the process by which infants develop into normal human as socialization. Thus, at the start of our lives, we are not social because we are unable to understand the meaning of the behavior of those around us or to interpret the symbols they use to communicate. Indeed, Cooley (Winterer, 1994) and Mead rejected a ‘behavioristic’ view of human beings, the view that people blindly and unconsciously respond to external stimuli. They believed that people had consciousness, a self, and that it was the responsibility of the sociologists to study this aspect of social reality (Ritzer, 2003).
Cooley (1922), for instance, introduced the term ‘looking glass self’ to describe the process by which our sense of self develops. Through symbolic interaction, human serve as mirrors for one another. Whether we hold a good or poor opinion of ourselves depends upon our relationships with other people. The greater our skill in bringing our actions into accord with theirs, the better is their opinion of us; they reflect that opinion back to us, and the more certain we become of our own worth (Stark, 1989).
Mead’s (1934) work represents an advance over Cooley’s (Ritzer, 2003). He distinguished two aspects of humans that arise out of the socialization process; the ‘mind’ and ‘self’. We must acquire certain skills in order to interact: we must learn to use and interpret symbols. Mead used the concept of ‘mind’ to identify our understanding of symbols, arguing that the mind arises wholly out of repeated interaction with others. The ‘self’ also arises through social interaction (Stark, 1989). Through long experience in seeing others react to what we do, we not only get a general notion of who we are but also are able to put ourselves in another’s’ place of what they want and expect and of how they are likely to react to us. That is, in order to know what we are like, we also have to know what they are like. Out of this tension between us and others, the self is formed.
Symbolic interactionists are, therefore, interested in the ways people interpret the social world and the meaning ascribed to it. Many sociologists have applied this approach to the realm of health and illness in order to understand how people experience being ill or perceive the illness of others. How do people react and adjust to news about a serious illness? How does illness shape individuals’ daily lives? How does living with a chronic illness affect an individual’s self-identity? (Giddens, 2006).
In an article entitled, “Deviance Disavowal: the Management of Strained Interaction by the Visibly Handicapped”, Fred Davis, using interactionists' perspective, examines interaction situation involving physically handicapped and normal person. The handicapped person wishes to present himself as ‘someone who is merely different physically but not socially deviant’. He seeks to achieve ease and naturalness in his interaction with other since this will symbolize the fact that they have accepted his preferred definition of self, but his handicap poses a number of threats to the type of sociability he desires. This stems from the fact that he is defined as ‘different’, ‘odd’ and something other than normal by those who do not share disability (Haralambos & Holborn, 1980).
Davis discovered that the first threat to sociability involves the possibility that others will be pre-occupied with the handicap. A second threat to sociability arises from the possibility that the handicap will lead to displays of emotion which exceed acceptable limits. Thus normal may be openly shocked, disgusted, pitying or fearful. Such emotional displays overstep what is usually considered appropriate and so place a strain on the interaction (Haralambos & Holborn, 1980). Finally, sociability may be threatened by uncertainty concerning the ability of handicapped person to participate in particular activities.
Having examined the threats that a visible handicap poses to the framework of rules and assumptions that guide sociability, Davis then looks at the way handicapped persons cope with these threats. He argues that the handicapped attempt to disavow deviance, to present themselves as normal people who happen to have a handicap. Davis identifies three stages in the process of deviance disavowal and normalization (Haralambos & Holborn, 1980). The first stage is called ‘fictional acceptance’ where the interaction is kept at a bare subsistence level of sociability. The handicapped person is treated like the poor relative at a wedding reception. At the second stage the handicapped person must redefine himself in the eyes of others i.e. he must project images, attitudes and concepts of self which encourages the other to accept him as a normal person. Finally, at the third stage the institutionalization of normalized relationship is done. And once a normalized relationship is institutionalized the strains which previously beset the interaction process are largely removed.
Therefore, looking at the interaction situation of the People Living with HIV/AIDS (PLWHA) and ‘normal’ people one would come to understand similar trends of relationship between the two classes of individuals – PLWHA and ‘normal’. Thus, while symbolic interactionism suggests that social life can only proceed if the meanings of symbols are largely shared by members of society, the sharing of these meanings do not usually exist between PLWHA and the ‘normal’ individuals. In other words, the PLWHA, as they in many cases see themselves, are not seen as normal individual members of the society even though they might expect normalized relationship with other members of the society. They are seen as social and religious deviant; hence their psychology would be affected adversely making them unable to adjust to a normal way of interaction with the rest members of the society (Abdullahi, 2004). Moreover, in his study of Risk Perception and Stigma in Jigawa State, Zango (2004) shows 62% of the sample said PLWHA are either very likely or likely to be avoided and 70% said people are likely to be uncomfortable with HIV/AIDS positive people.
Possibly, this is where Voluntary Counseling and Testing Centers (VCTC) could come in to help remedy the situation by institutionalizing ‘normalized’ interaction (relationship) between PLWHA and ‘normal’ individuals. Perhaps, through the VCTC’s services PLWHA could be made to ‘disavow deviance’ and perhaps live a normal life, since the ‘normal’, through the same services could also be made to accept the former as ‘normal’ human beings like them.
But other sociological theories, especially the two major ones - conflict and functionalist theories - would not adequately explain the situation under study, perhaps, because they are macro theories.
For instance, Karl Marx (1818-1883), who was an early conflict theorist, presented the basic arguments of conflict theory where he argued that social structures were created by the most powerful members of a society, the ruling class. He further argued that the ruling class constructs social structures that best serve its own interests and, conversely, that the social structure determines who will be the ruling class. Thus Marx traced the origins of social structures to class conflicts (Stark, 1989). Conflict theories, then, are concerned with the distribution of power in societies (not personal interactions per se) and how various interest groups (including classes) seek and gain power and utilize their power to shape social structures. From this perspective, therefore, any society at any given moment is the result of past compromises and power struggles (Dahrendorf, 1959; Habermas, 1975; Stark, 1989). Hence conflict theory would not sufficiently serve as a framework in this study since we are not talking about power distribution, economic means, class or construction and maintenance of social structure to serve the purpose of few.
Functionalist theory, as a macro theory also, holds that society is a complex system whose various parts work together to produce stability and solidarity. According to this approach, the discipline of sociology should investigate the relationship of parts of society (institutions) to each other and to society as a whole. For example, we can analyse the religious beliefs and customs of a society by showing how they relate to other institutions within it, for the different parts of a society develop in close relation to one another (Giddens, 2006). Functionalism emphasizes the importance of moral consensus, in maintaining order and stability in a society. It regards order and balance as the normal state of a society. Until the 1960s, functionalist thought was probably the leading theoretical tradition in sociology, particularly in the United States.
In recent years, however, the popularity of functionalism has begun to wane, as its limitations have become apparent. For example, the focus on stability and order means that divisions or inequalities in society – based on factors such as class, race and gender – are minimized. There is also less emphasis on the role of social actions within society (Giddens, 2006). Again, the functionalist theory is not well equipped to handle issues such as the one in this research as it is social action based.
CHAPTER THREE3.0 HISTORY OF THE RESEARCH AREA AND METHODOLOGY
In this chapter, an attempt would be made to bring a brief history of the research area and the methodology of the research. Doing this could help one to have a bit knowledge of the area of the research and the methodology that was employed in carrying out the study, which could consequently make one to comprehend the direction and import of the study.
3.1 HISTORY OF THE RESEARCH AREA
The history of the VCTC at Aminu Kano Teaching Hospital, Kano, started in March 2005 when the center was established with funding from The President’s Emergency Plan for Aids Relief (PEPFAR) of the US. Prior to the establishment of the center, its activities were carried out by a sub-unit in the Social Welfare Unit of the Aminu Kano Teaching Hospital.
According to Malama Zainab Kuliya, a counselor and spokesperson of the center, the center is established purposely to carry out activities that are directly related to HIV/AIDS prevention, counseling and HIV/AIDS voluntary testing. The center distributes pamphlets that contain information about the HIV/AIDS issue.
The VCTC staff work as a team with HOD Haematology, Dr A’isha Kuliya, as the focal person. The personnel in the team consist of medical doctors, nurses, pharmacists, counselors, receptionists and even the clients. The Chief Medical Director of the AKTH serves as Project Director as well as the Project Coordinator.
The center has six counselors, each of them a graduate or trained counselor. Four of them work at the center while one counselor represents the center at the Blood Donor Clinic; the other counselor works at the Specialty Clinic also as representative of the center. According to Malama Zainab, the center usually receives 15-25 clients daily in all the three places put together, mostly people of different Nigerian ethnic groups. At its establishment the center charged #1,000 for HIV/AIDS test. But by the end of its first year, the center, with the support of the US government through PEPFAR, makes HIV/AIDS test free of charge. The center opens throughout the week from 8am to 4pm except weekends.
3.2 METHODOLOGY
Under this sub-heading the size of the population as well as the sample size would be discussed. The sampling method and the technique of data collection as well as the technique that was used in analyzing the data in this research would also be presented.
3.2.1 Population Size
Population refers to the people on whose research is being conducted. In this research, every client that visits the VCTC at Aminu Kano Teaching Hospital during the research forms part of the population size during the study. The population is heterogeneous with members having different cultural and religious affiliations. Their ages range from 12-60 years, of male and female gender and are of different marital status. They have different educational background as well as occupations.
3.2.2 Sample Size
Considering the researcher’s available time and resources at his disposal, the population is large. It becomes necessary therefore to study a sample population which can represent the entire population. One can be confident that results from a population sample, as long as it was properly chosen, can be generalized to the total population. Studies of only two or three thousand voters, for instance, can give a very accurate indication of the attitudes and voting intentions of the entire population (Giddens, 2006). Therefore, one hundred people were sampled in this study, whereby fifty percent of it was selected at the center while the other fifty percent was selected equally from the clients at the Blood Donor Clinic and the Specialty Clinic. This was done in order to take care of any possible and reasonable differences that may exist in either the composition of the sample or the services they receive at these three different points.
3.2.3 Sampling Method
The method of sampling requires that those included in the sample are like those who are not included (Stark, 1989). In this study the researcher used accidental method due to the fact that the other methods may not be suitable as they could be difficult to use looking at their requirement; and more importantly because the sampling method so selected (accidental) would serve the need of the research. As the name implies, the accidental sample consists of units which are obtained because cases are readily available. In constructing the accidental sample (which is also referred to as availability sampling), a researcher determines the desired size of the sample and then simply collects data on that number of individuals (Leming, 2007).
3.2.4 Data Collection Technique
A method (technique) of data collection is selected in consideration of the nature and characteristics of a population. The aim is to collect as much information as is possible from the population or sample. Thus, a method can be suitable or otherwise depending on how easily it can provide the required data (Umar, 2005). Having this in mind therefore, the researcher has used a questionnaire that has a list of preset questions to which respondents were asked to supply answers.
With questionnaire, this study (could) have the required data. Moreover, HIV/AIDS issue is a very sensitive issue that many people may not like to discuss or say something about especially through personal interview. But questionnaire gives the individual the freedom to say ‘everything’ he/she knows about an issue. Indeed, questionnaire do provides reliable data which can be easily quantified and analysed.
3.2.5 Technique for Data Analysis
From what is so far stated, especially under the aims or objectives of this research, it is obvious that this research intends to establish the relationship that may exist between variables through quantifying the gathered data. In other words, quantitative analysis was used to analyze the data that was gathered during the research. It should be remembered that quantitative analysis uses percentages and frequencies in comparing the outcome of a research data. Moreover, the data was organized using the variables age, marital status, level of education, occupation and sex of the respondents.
CHAPTER FIVE5.0SUMMARY,CONCLUSION AND RECOMMENDATIONS
This is the last chapter in this research. Here, the researcher would try to summarise what was so far presented in the previous chapters, make conclusions and offer some recommendations, where necessary, on the issues researched upon.
5.1 SUMMARY
In previous chapters, the researcher tried to acquaint the reader about what a HIV/AIDS is all about – when it was first discovered, at where and how it became a global problem. The researcher stated that no disease is posing a great danger to both political and socio-economic life of the world population like the HIV/AIDS. The disease continues to affect human endeavor in all its ramifications. Hence there is a need for an urgent and sincere efforts to stop this process of destruction by a disease that have since took an epidemic dimension.
The researcher maintained previously in a chapter that since there is no substantive cure for HIV/AIDS up till this time but only preventive measures, research such as this one could help in preventing the spread of the disease. In simple terms, this is one of the objectives of the research. Although the scope of the research seems to be narrow as a result of limited time and resources, nonetheless, using a methodology of social research, the researcher was able to find out something that could shed more light on the effectiveness of Voluntary Counseling and Testing in HIV/AIDS prevention which is another objective of the research.
5.2 CONCLUSIONS
Based on the data collected in this research, the researcher observed certain things and therefore draws some conclusions. Thus, HIV/AIDS affects all age groups; the data in this research indicates, however, that some certain age groups are not forthcoming for Voluntary Counseling and Testing (VCT) (see Table 2, Chapter 4). This is therefore not encouraging. Moreover, divorced and widowed respondents did not form significant percentage in the overall sample, even though the married and single percentages are significant. This could also not augur well for HIV/AIDS prevention, being divorced and widowed females very strategic in HIV/AIDS transmission and prevention (see Table 3, Chapter 4). Furthermore, although there is reasonable attendance of the center by both Muslims and Christians, their religious centers (mosques and churches) do not contribute in motivating them to come forward for the VCT (see Tables 6 and 7, Chapter 4).
The nature of counseling services is discovered to be more interactive; perhaps, it was what makes the respondents to have more knowledge about ways of transmitting and protecting themselves from HIV/AIDS (see Tables 10 and 11, Chapter 4). This The researcher further concludes that most of the respondents believed in abstinence and being faithful to one’s partner as the best ways of protection from HIV/AIDS rather than the use of condom (see Table 12, Chapter 4). Again, the researcher observes that many people have begun to agree to be tested for HIV/AIDS very early because it is the right thing to do, and that if tested positive they would continue to see a doctor to monitor their immune system despite the fact that there is no cure for HIV/AIDS yet (see Tables 14, 15 and 17, Chapter 4); thus, only a few people refused to be tested early because of the fear of positive result (see Table 16, Chapter 4). This is a positive development. And, although stigma is believed to be an obstacle in HIV/AIDS prevention, many people do not know antiretroviral drugs. Lastly, though the center is not without its problems, most people are generally satisfied with the services, hence the center could be described as very effective in HIV/AIDS prevention (see Tables 25 and 27, Chapter 4).
5.3 RECOMMENDATIONS
Even though the findings in this research have indicated that the Voluntary Counseling and Testing (Center) is effective in HIV/AIDS prevention, nonetheless, so many things need to be considered if the VCT is to adequately achieve its purpose. Therefore, the researcher makes the following recommendations:
1. The VCTC should have a permanent building as other departments of the hospital have. This could make the center have enough space to deliver its services more effectively.
2. There is a need to employ more staff to complement the current ones so as to be able to serve the large turnouts of the clients efficiently.
3. In this age of information technology, there is a need for the center to have computer systems and be connected to the Internet as this could help the center to have access to new developments in VCT services as they happen.
4. The counselors at the center should make sure that every client that comes for counseling is told about antiretroviral drugs as doing this could make them to agree to be tested for the disease
5. The center should make sure that any client tested HIV+ is assured of and is provided with required antiretroviral drugs. This could make the clients to tell others about the VCTC.
6. Family, peer groups as well as the general public should learn to accommodate People Living with HIV/AIDS which could help in reducing the latter’s psychological stress and could possibly make them to avoid all avenues of transmitting the disease.
7. Enough publicity should be done using various media outfits, especially the radio, about the existence and the services offered at the center.
8. HIV/AIDS campaigns should emphasize abstinence from sex and being faithful to one’s partner as the best ways of prevention of the disease more than the use of Condom.
9. Various religious groups and organization should participate in HIV/AIDS prevention by motivating their followers to go for voluntary counseling and testing.
10. Our governments at various levels should double efforts in the fight against HIV/AIDS by providing enough support in terms of finances and other resources HIV/AIDS campaigns should emphasize abstinence from sex and being faithful to one’s partner as the best ways of prevention of the disease more than the use of Condom.
11. NGOs, CBOs, etc. should not relent in their effort in the prevention and possible cure for HIV/AIDS. Thus, they should continue to support various initiatives that are geared towards the HIV/AIDS prevention and cure.
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